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BUSINESS CERTIFICATE# 09—off <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE / <br /> DATE <br /> Expiration Date: December 31, 2013 <br /> In conformity with the provisions of Chapter one hundred and ten, Section fiveof the General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of .. . . .. <br /> Lgi,j Lam(, SSL Ckrl�'Ynf'Lr DBA �3MCt$ Cc rylTotjL( is conducted at <br /> Business Location:��t�-+S La f\yC.re\ %)n`tQ- , Aa. IInpQ CY7P' Od-Q q <br /> tl sh,ps �ndcrn l7ttic <br /> Business Mailing Address: �/ <br /> Business Type: ) aLo V f��IGZ Business Telephone: <br /> by the following named persons: - - <br /> FULL NAME RESIDENCE <br /> I�t�ImGS Pa l r�rbc L`Ksr�r,�r �� SIS, �r�v�k tvl �^ty�, !✓��S�n fl1A 0 46 <br /> Home Phone: a" <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid allstate <br /> Ps as required under law. <br /> -W � 40&4 <br /> *Signature of authorized agent Y *Signature of authorized agent <br /> **Social Security Number(Voluntary) --- <br /> or Federal Identification Number -- - <br /> Ln case of emergency - - <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> *This license will not.be issued unless this certification is signed by applicant <br /> **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A: <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE /a /7' o2G17S� <br /> Personally appeared before me the above-named�Orrrty Qt-1�1't.�Leta gen $ and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as such business sssh��all be conducted and shall lapse and be void unless so renewed. <br /> • <br /> Signed ( f1iY t� t�'7/t'- <br /> Margaret C. Santos cro <br /> NOTARY PUBLIC � tary Public <br /> SEAL \u Commonwealth of Massachusetts <br /> Vly Commission Expires Sept.24,9010 a 4- aold <br /> Commission Expires: <br />